What stress really does to our health

What is stress?

Stress is that feeling we often get when we’re overwhelmed or when we have more on our plate to deal with than usual. It is a daily occurrence and it’s what allowed cavemen to survive the myriad of dangers that existed for them. Looking behind the scenes, stress is how our body reacts to changes or situations that require a response. This reaction is a combination of emotional, physical and mental responses.

It can be helpful to think of stress as our ‘fight or flight’ response in which adrenaline, cortisol and norepinephrine are released. These are the chemicals and hormones designed to help put you in gear for a quick, physical response to something. You will probably recognise this as feeling a sudden rush of energy, heightened awareness, increased heart rate and feeling as though you are breathing faster.

But how helpful is the ‘fight and flight’ response really? Extremely if we have to react quickly, such as performing an emergency break whilst driving, or running after a child along a busy road. It may not be so helpful when your ‘fight’ response leads you to offend or be aggressive towards a non-violent threat (e.g. a disagreement with a colleague), or when your ‘flight’ response leads you to avoid dealing with something, which then causes further stress when that problem gets worse or doesn’t go away.

However, we don’t exactly live in fear of being attacked by sabre-toothed cats anymore, so why does our body still respond in such a way? Why does it seemingly set us up for failure? This can be explained by how often we are stressed and for how long.

When does stress become a problem?

To a point, stress is undeniably helpful. When we are in control of our stress levels, it helps us to focus and to get done what needs to get done. When we lose control of our stress, this is when it becomes problematic. Uncontrolled stress can result in sleep-loss, a lack of focus, indecision, irritability, poor judgment and self-doubt.

Stress that is episodic or occasional is normal, and it protects us. Stress that is chronic and long-term is harmful and unhelpful.

How can we identify chronic stress?

If you are chronically stressed, the chances are that you will identify with some, or all, of the following statements:

• You experience mood swings and irritability.
• You find it challenging to relax and distract yourself from your stress.
• You are stressed despite the original stressful event having happened months, or even years, ago.
• You have noticed certain physical changes in your body (e.g. tiredness, weight loss or gain, heart palpitations and general anxiety).

If you do feel like you’re affected by chronic stress, understand that it is reversible and you can overcome it.

Can stress be measured?

Everyone deals with stress differently. Some might be completely unfazed by presenting at an important meeting, whilst others would find this prospect extremely stressful. Therefore, if stress is subjective like this, can it be measured? If it can be measured, how helpful is this?

Two researchers in the 1960s called Thomas Holmes and Richard Rahe certainly thought so. In fact, they hypothesised that if it could be quantified, and then ranked, we would be able to predict future illness. They set to work to test this theory by assessing more than 5,000 patients’ medical records to glean if there was indeed a correlation between experiencing stressful life events and serious illness. They soon found that there was such a correlation. Next, they went to work on ranking stressful events on a scale, ranging from ‘most stressful’ to ‘least stressful’. It was their hope that such a ranking could help to identify people at risk of developing poor health. This ranking is now known as the Holmes and Rahe Stress Scale.

How is this scale used to predict the likelihood of illness?

Each stressful event is given what is called a ‘Life Change Unit’ score. You then add together the score for each stressful event you have had within that year and any that are likely to happen in the near future. If your score adds up to 300 or more, then it is said you have an 80% likelihood of illness.

If we run with the theory that stress can be quantified and ranked, we can identify what seven of the most stressful events in life can be. Whilst you might think that these are fairly obvious, it is important to acknowledge them and understand that we might need extra support if we are going through any of these.

1. Death of a spouse: 100
2. Divorce or a break-up: 73
3. Moving to a new home: 25
4. Losing your job: 47
5. Money trouble: 38
6. Marriage: 50
7. Retirement: 45

How does stress make us sick?

Holmes and Rahe based their findings on the correlation they found between the lives of those who had experienced stressful events and the illnesses they developed. However, they did not explain why stress causes illness. For that, we asked Dr Boon Lim, a leading cardiologist and expert in the phenomenon of stress-induced illnesses, to explain how experiencing stress can lead to sickness.

One way to understand stress-related illness is to imagine the direct impact of stress on our bodies. The primitive brain, or autonomic nervous system, which controls the automatic bodily functions, triggers the release of adrenaline, cortisol and noradrenaline. This sets up a multifaceted cascade of events, including increased heart rate, blood pressure, breathing rate, changing blood flow to our gut and increasing hyper-vigilance/anxiety. These changes in bodily function are usually immediately helpful when dealing with an immediate situation for optimal performance (i.e. running away from that sabre-toothed cat!).

In modern society, with chronic stresses in day-to-day work and life, this pattern of repeated activation of the autonomic nervous system creates problems including:

• Anxiety
• Depression
• Arrhythmias including ventricular ectopy
• Atrial Fibrillation (AF)
• Heart Attacks
• Irritable bowel syndrome (IBS)
• Acid reflux
• Type 2 diabetes
• Heart disease
• High blood pressure
• Chronic back and neck pain
• Accelerated ageing
• Obesity, weight-gain and overeating
• Insomnia (poor sleep patterns)
• Substance abuse (drugs and alcohol)

To demonstrate this link between stress and illness, we can look at numerous scientific studies conducted, such as the large population study carried out called INTERHEART that had approximately 25,000 subjects from 52 countries. The INTERHEART group of investigators showed that chronic psychosocial risk was as strong as traditional risk factors, such as high cholesterol or diabetes in causing cardiovascular disease, including acute heart attacks.

In addition, Dr Boon Lim has specifically studied the role of the autonomic nervous system (i.e. the system which governs the stress response) in relation to patients undergoing keyhole surgery for atrial fibrillation as part of his PhD at Imperial College London. Here is what he found out through this research:

“Our study findings suggest that there are direct nerve inputs into the heart, which can be activated to trigger heart rhythm abnormalities, and that ablation of these nerves may help to prevent recurrence of atrial fibrillation.”

Furthermore, research by Dr Greaney, published in the Journal of American Heart Association in January 2019, showed that even acute exposure (within one day) of naturally-occurring psychosocial stress is associated with impairment in the micro-circulation within the lining of blood vessels, contributing to increased cardiovascular risk. This causal relationship between stress and impairment in circulation provides the direct mechanistic link between stress and significant cardiovascular events.

So, what can you do about your stress?

Handling our stress is as important as looking after our physical health. However, making this element of self-care part of everyday life can be easier said than done. In the future, there is hope that stress management will be integrated into our wider picture of health, and Dr Boon Lim believes that “stress resistance and resilience may mitigate the risk of stress, and needs to be brought into wider focus in school and the workplace”.

In terms of taking your stress management into your own hands, the following steps are recommended to help handle it better:

• Take deep breaths (try breathing exercises for example by performing yoga, pilates, meditation)
• Acknowledge what you are feeling
• Acknowledge exactly what is causing you to feel stressed
• Move your body, exercise is great for unwinding
• Reach out to others
• Take some time to relax and have fun
• Eat well
• Don’t reach for the bottle (or the cigarettes)
• Get enough sleep
• Avoid using caffeine to propel you through the day
• Manage your time better and try to prioritise

If you are finding it impossible to work through your stress, some find it extremely helpful to get professional help from a psychologist or psychiatrist that specialises in stress management. They will be able to offer you coping techniques (e.g. cognitive behavioural therapy), identify the causes of your chronic stress, and give you time off work if they deem it be necessary. Being open and honest about what you are feeling and acknowledging that there may be a problem is the best way to get started.